HEDIS ® Medicare Health Outcomes Survey (HOS) Sonya Bowen, MSW HOS Program Administrator

What is the Medicare HOS? HEDIS Effectiveness of Care measure implemented by CMS in 1998 HEDIS Effectiveness of Care measure implemented by CMS in 1998 Annual survey of 1,200 randomly selected (non-ESRD) Medicare beneficiaries from EACH eligible MAO at contract level Annual survey of 1,200 randomly selected (non-ESRD) Medicare beneficiaries from EACH eligible MAO at contract level Collects longitudinal health status data (remeasurement at 2 years) Collects longitudinal health status data (remeasurement at 2 years) Self-administered mail survey with telephone follow-up Self-administered mail survey with telephone follow-up

Who must report HOS? Required MA Contracts: local and regional coordinated care plans (all types), SHMO, 1876 cost (w/ open enrollment) Required MA Contracts: local and regional coordinated care plans (all types), SHMO, 1876 cost (w/ open enrollment) Voluntary MA Contracts: PFFS Voluntary MA Contracts: PFFS Contract Effective Date: On or before Jan. 1 of year preceding measurement year Contract Effective Date: On or before Jan. 1 of year preceding measurement year Minimum Enrollment Threshold: 500 Minimum Enrollment Threshold: 500 Note: Employer/Union, MSA, 1833 Cost, and Demonstration contracts excluded Note: Employer/Union, MSA, 1833 Cost, and Demonstration contracts excluded

Special Needs Plans Prior to 2008, MA contracts with exclusive SNP enrollment exempt from HOS (with exception of LTC demo plans in HOS-M) Prior to 2008, MA contracts with exclusive SNP enrollment exempt from HOS (with exception of LTC demo plans in HOS-M) New in 2008 New in 2008 –Otherwise eligible MA contracts comprised of one or more SNP PBP must participate in HOS –Sampled and collected at contract level, inclusive of all SNP and/or non-SNP benefit package(s)

Goal of HOS Program Collect valid and reliable data that may be used to promote: Managed Care Performance Assessment Managed Care Performance Assessment Quality Improvement Quality Improvement Beneficiary Choice Beneficiary Choice Outcomes Research Outcomes Research

HOS-Modified (HOS-M) Shorter, modified version of HOS instrument Shorter, modified version of HOS instrument Allows CMS to adjust payment for PACE and former long term care demo plans (latter plan-type will phase into HOS in 2010) Allows CMS to adjust payment for PACE and former long term care demo plans (latter plan-type will phase into HOS in 2010)

Survey Content Physical Health Status Mental Health Status Chronic Medical Conditions ClinicalSymptoms Activities of Daily Living DepressionIndicator SmokingStatus HEDIS Measures: UI/Falls/Phys Act/Osteo Healthy Days Demographics Height & Weight

Included HEDIS Measures Management of Urinary Incontinence in Older Adults Management of Urinary Incontinence in Older Adults Physical Activity in Older Adults Physical Activity in Older Adults Fall Risk Management Fall Risk Management Osteoporosis Testing in Older Women Osteoporosis Testing in Older Women

HOS Outcome Measure % whose physical and mental health improved over two years; % whose physical and mental health improved over two years; % whose physical and mental health remained the same over two years; and, % whose physical and mental health remained the same over two years; and, % whose physical and mental health declined over two years. % whose physical and mental health declined over two years. * All numbers are case-mix and risk adjusted for valid comparison between health plans.

How does CMS use HOS results? Monitor health plan performance Monitor health plan performance Reward top performing plans with regulatory relief Reward top performing plans with regulatory relief Construct a frailty adjustor for payment purposes (HOS-M) Construct a frailty adjustor for payment purposes (HOS-M) Inform agency programs and priorities (e.g., health care disparities, disease management, disabled) Inform agency programs and priorities (e.g., health care disparities, disease management, disabled)

How do MAOs and QIOs use HOS results? Identify opportunities to improve care Identify opportunities to improve care Target quality improvement activities and resources using HOS tools Target quality improvement activities and resources using HOS tools –Beneficiary level data and data user guides –Summary level Baseline Profile & 2-Year Performance Measurement (PM) reports –HOS technical support –Best practice & applied research results

Annual Survey Administration Notify eligible MAOs Nov-Dec Finalize survey specifications Dec-Jan MAOs contract with HOS vendors January Train & certify HOS vendors February Baseline & Follow-Up sampling March Field Baseline survey April-June Field Follow Up survey May-July Survey data submissions Aug-Sept Test, clean, & score data Sept-Dec

HOS Data Reporting Baseline Data Analysis January PM Data Analysis Feb-March Baseline Report Production Feb-May PM Report Production Apr-June Baseline Report Release May Baseline Data Release (QIOs only) June PM Report Release July PM Data Release (MAOs & QIOs) August

HOS Resources Web: Web: Technical support for end-users Technical support for end-users Toll Free: (888)